Forensic examination of injuries and in cases of violent death.

Injuries caused by blunt and sharp objects.

 

As stated before, an injury means a disorder of an anatomic structure (continuity) or physiological function of human tissues or organs caused by the action of different environmental factors (mechanical, physical, chemical etc.). Mechanical factors are always combined with the motion of a traumatic instrument on a human body (as in a blow) or on the contrary when the moving body strikes a fixed object or surface (as in a fall). These factors resulting in formation of mechanical injuries on human tissues. Such injuries are so different and first of all depend on the mechanism of traumatic action on the body, physical properties of the surface of an applied traumatic instrument (shape of the object) and its kinetic energy.

So, the object which can stretch, squeeze, tear and deform human tissues, resulting in definite injuries (scratches, bruises, abrasions, lacerations, fractures etc.) is termed as blunt.

If a traumatic instrument punctures or cuts the tissues, is concentrated over a small area and has a pointed end or edge it is termed as a sharp object (knife, broken glass, jagged metal).

High velocity of traumatic object (for example a bullet) inflicts the injury due to great kinetic energy of an object. This is firearm.

That’s why forensic medicine distinguishes three main types of traumas respectively:

·     Blunt

·     Sharp

·     Firearm

Types of blunt objects. In our opinion the most successful classification of blunt instruments was given by the prominent Ukrainian forensic pathologist, associate-professor A. Mukhanov (1974, 2008). On the base of huge value of experimental and scientific investigations he established such types of blunt instruments:

 

So, the object which can stretch, squeeze, tear and deshape  a human tissue, resulting in definite injuries (scratches, bruises, abrasions, lacerations, fractures etc.) is termed as blunt.

 

Some kinds of Blunt objects

 

 

WOUND: (legal definition):' breach of the full thickness of the skin (or lining of lip). This excludes abrasions, bruises, internal injuries and fractures!

WOUND: (medical definition)' disruption of the continuity of the tissues produced by external mechanical force'

INJURY: from the latin injuria (in- not, jus- the law). The term is often used synonymously with wound but can have a wider use, including damage to tissues by heat, cold, chemicals, electricity, radiation, in addition to mechanical force

LESION: from the latin laesio (a hurt). Originally meant injury, now more widely applied to include '' any area of injury, disease or local degeneration in a tissue causing a change in its function or structure''

TRAUMA - bodily harm with or without structural alterations resulting from interaction with physicochemical agents, imparting energy to tissues.

May cause morphologically apparent damage (wound) or produce physiological imbalance (eg reflex cardiac arrest by neural stimulation) and secondary effects (eg thrombosis, infection, obstruction of tubular organs)

TYPES OF TRAUMA

Energy may applied to tissues in various forms :

1) Mechanical Force

Blunt force trauma (BFT)

-a moving object (KE) striking the body as in a blow

-the moving body (KE) striking a fixed object or surface as in a fall

BFT causes bruises, abrasions and lacerations

Sharp force: knife tip or edge, broken glass, jagged metal

- applied force is concentrated over a small area, requires little force to cut tissues

Firearm; high velocity, small mass projectile

2) Thermal energy: heat or cold

3) Electrical energy: flow of current may cause localised burn if resistance is high

4) Atmospheric Pressure: high or low, in air or water

5) Radiation: particle or radiation

6) Chemical reaction with tissue releasing energy

Mechanical Force may cause Impact, Angulation, Compression, Traction, Torsion, Shearing, Acceleration/deceleration (RTA)

Different tissues have varying properties of

Elasticity (tendency of stressed material to regain its unstressed condition

Plasticity (tendency to remain in stressed condition)

Viscosity (resistance to change in shape when stressed)

Different tissues therefore have different elastic limits (tolerance limits or break points) and are vulnerable to different stresses. Skin has greater elastic limit than underlying fat and blood vessels making subcutaneous bruising more common than skin laceration e.g. torsion often causes spiral fracture of tibia, soft tissues undamaged compression often causes rupture of gas-filled lung or intestine, but muscle and skin undamaged Injury occurs when energy applied exceeds the elastic limits (or tolerance) of the tissues.

Whether or not injury occurs following the application of energy, in whatever form, depends on Physical and Biological factors.

PHYSICAL FACTORS

1) Degree of Force or K.E. applied:

Force = Mass x Acceleration

Kinetic Energy = 1/2 Mass x Velocity2

Energy depends on mass of weapon or projectile, but on the square of its velocity

Crash energy = (mph)2 x 0.034 Stopping distance in feet

2) Area over which force is applied:

-same force spread over larger area is less likely to injure at site of impact edge or tip of knife allows a great concentration of force applied edge of a plank is more damaging than its flat face heel of stilletto is more damaging than its sole

Soft object deforms and flattens

3) Duration over which force is applied:

longer duration allows tissues at site of impact to deform and dissipate the applied energy eg fall onto soft surface (increases duration and area of impact) seat belt stretching slows down the rate of transfer of kinetic energy to the body and spreads the area of impact over the trunk (c.f. forehead on dash)

4) Direction of application:

Transfer of kinetic energy from weapon or projectile is incomplete with a glancing blow or exiting bullet (some wounding potential is wasted) and complete when the weapon or bullet come to rest on/in the body

BIOLOGICAL FACTORS

1) Mobility of the body part

Fixed parts absorbs all applied energy.

Mobile parts are able to transform KE into movement

2) Anticipation and coordination e.g.-boxer rolling with a punch spreads out the duration of impact, catching a cricket ball, rolling with a fall

3) Biomechanical properties of tissue

Different tissues have different strengths and weaknesses

-skin is elastic and more resistant than underlying tissues (Bruise > Laceration)

-blood vessels more resistant to compression than stretching

-bone more resistant to bending than to torsion

-hollow or fluid-filled organs sensitive to compression

-brain (semi-fluid) more resistant to direct impact than rotational impact (--> shearing of nerve fibres)

-bone and joint may transmit force to a weak point

 

 

 

INJURIES caused by BLUNT OBJECTS

 

We name blunt such objects, which, operating on man body by its traumatizing surface, squeeze, deshape, drag apart the cloths, causing the injuries typical for them:  abrasions, scratches, bruises, wounds, breaks, fractures, etc.

There are such types of  blunt objects  (for À.².Muhanov, 1974, 1988):

 

1.Objects with flat prevalent surface.

2.Objects with flat limited surface.

3.Objects with spherical surface.

4.Objects with cylindrical surface.

5.Objects with trihedral corner.

6.Objects with rib or dihedral corner.

 

 

Blunt objects inflict definite kinds of the injuries: abrasions, scratches, bruises, wounds, fractures, placing, breaks of internal organs and cloths, etc.

 

Abrasions, (scratches, excoriations)

 

Abrasions (lat. — excoriationes).  From L atin a b- from and r adere- t o scrape Syn. Scratch, Graze Defn. " a portion of the body surface from which the skin or mucous membrane has been crushed or removed by rubbing" A superficial injury, not involving the full thickness of the skin, i.e. confined to epidermis/dermis.

 

Typical abrasion

 

Due to

·        Direct impact: imprint (may reflect pattern of causative surface) or

·                Tangential impact: graze or scratch (may reflect direction of impact)

An abrasion is a superficial injury of the outer layer of the skin or mucous membrane caused due to friction of a blunt object against the skin or sliding the body against a rough surface. In other words friction and pressure between the skin and some rough object are the main factors in formation of an abrasion. If sufficient force is applied, the removal of the epidermis may occur and the superficial layer of dermis is injured only (superficial abrasion). If a traumatic object inflicts more rapidly or its traumatic power is significant, deeper layers of the skin are damaged and a deep abrasion is formed. However, only some layers of dermis (not all thickness of the skin or mucous membrane) are injured in an abrasion, therefore it heals rapidly without scar formation.

Types of abrasions. Medicolegal classification of abrasions depends upon the manner in which they are caused. 1. Scrat­ches — the linear injuries produced by a sharp object (pin, finger nail) running across the skin. 2. Grazes — produced when a broad surface of skin scrapes against a rough surface (com­monly seen in a traffic accident). They are the most widespread. 3. Contact or patterned abrasions are caused as the result of a direct impact or pressure with an object which, crushing the cuticle, stamps a reproduction of its shape and traumatic surface marking upon the skin (teeth marks, tyre marks, ligature marks).

Direction of applying force may be determined in an abrasion by the following morphological features: a serrated border initially and heaped up epithelium at the end. Abrasions always occur at the site of an impact. Due to a direct impact a contact abrasion is formed (imprint). A tangential impact is typical for grazes or scratches (may reflect direction of an impact)

Age of abrasions. The surface of fresh abrasion is bright whether pink-red, moist and its bottom settles down below the level of the intact skin. Healing of an abrasion is accompanied with exudation of fluid lymph and blood and later the surface dries up with formation of a yellowish scab. It indicates time period approximately 12 hours — 3-4 days. After it epithelium covers the bottom and the scab exfoliates initially at the ends (7-12 days). When the scab completely exfoliates and pink smooth spot is formed in the place of an abrasion the age of abrasion is suggested 8-16 days and more. General features of abrasion healing are shown below: 

Surface of fresh abrasion is pink whether pink-red, moisture, soft, painful, disposed beneath of the surface of unharmed skin. After shapeation of abrasion on its surface comes forward a liquid, which contains albumens and cellular blood elements (excudate). Water partially evaporates, and albumen interfuses with epidermis remainders,  convolves and shapes on abrasion more-less thick crusta, which afterwards rises over skin surface.

Dimensions of separate  abrasions are small and vacillate in boundary paths 2-3 cm. The size of the abrasion  ordinary accords with dimensions of the surface, that rubbed, and to length of got through way.

On surface whether edges of the abrasions can be kept the exfoliated particles of the epidermis.  The top layers of the skin  sometimes take off by sliding object like the layer.

Abrasion has various shapes, but prevail indeterminate shape, round, oblong, like ribbon, broken for object sliding counting. 

À.².Êràt and V.M.Rubin (1982 y.) offered to distinguish such stages and periods in cicatrization of abrasions, which accomplishs into following middle dates:

1.stage - a fresh abrasion (first day);

2.stage - shapeation of crusta: 1st  period – crusta is beneath unharmed skin whether on its level (1-2 day); 2nd  period  -  crusta rises over level of ambient skin (3-8 day);

3.stage  -  falling away of crusta: 1st   period  -  the edges of crusta few elevated (6-10 day); 2nd  period  -  crusta partially fell away (8-15 day); 3rd  period  -  a full crusta felling away (11-18 day);

4.stage  -  traces from the abrasion  (on 30-150 day).

Fleecing of skin ordinary takes place posthumously. Surface, devoid of horny  layer, dry out, shapeing something deep-laid beeswax-grey whether brown-yellow blot, sometimes with red hue and  and looking over of vessels.

 

Forensic significance of abrasions.

·     This is the sign of violence

·     They suggest the action of a blunt object

·     They are seen at the site of external impact

·     Identification of causing object (patterned abrasion)

·     Kind of violence (on the neck — throttling, around nose and mouth — smothering, around genitals — rape)

·     Direction of applying force

·     Time of injury

      Severity degree — as usual simple.

 

 

BRUISES (ecchymoses)

 Bruise (from Old Englis  h b rysan- to crush, O ld French b ruser-t o break Syn. Contusion, Ecchymosis Defn. "escape of blood from ruptured small vessels (vein, capillaries, arterioles) into the surrounding tissues" The resulting discolouration is seen through the overlying intact skin. Due to blunt force trauma. Site, shape, size, severity of bruising are very variable

Bruise is an infiltration of the blood into the tissues following the rupture of vessels as result of application of blunt force

 

bruise

 

Haemorrhage or bleeding is the escape of blood from any part of the vascular system. Haemorrhage can also be external, from a skin wound, or internal into a body cavity. Bruising is haemorrhage into the surrounding tissues. Bruising may be seen in skin, muscle or any internal organ  video

Petechiae- pin head size bruise < 2mm

Due to BLUNT FORCE TRAUMA

Moving object strikes the stationary body (blow with fist or weapon)

Moving body strikes a stationary object (fall) pinching or squeezing

Often associated with skin abrasion or laceration (the more elastic overlying skin may be undamaged)

Bruising less often associated with incised or stab wounds which allow outward escape of blood from cut vessels

EXTERNAL BRUISING

Superficial bruise rapidly appears at the site of impact. Bleeding in the subcutaneous tissue seen as discolouration through the semi-translucent skin

INTERNAL BRUISING

Not visible at surface

Deeper bruise in muscle or internal organ will not be visible through overlying fat and skin. e.g. neck in strangulation, fatal brain injuries  video lows to chest & abdomen

The site of bruising does not necessarily reflect site of trauma.

Bleeding into tissues may continue for some time after impact under circulatory pressure.

Extravasated blood tracks along natural/traumatic planes of least resistance, influenced by gravity and body movement. e.g. blow on temple --> bruise on cheek fractured jaw --> bruising on neck fractured hip --> bruise on thigh

Delayed appearance on body surface

Deep bruising may take upto 24 hours to appear at surface (come out). Re-examination of a body or live victim after this time may reveal bruises not initially apparent. Ultraviolet light may

disclose an otherwise unidentifiable bruise. Breakdown of RBCs with time (haemolysis) eleases breakdown pigments which may spread outwards and stain the tissues over a wider area then the original intact red blood cells of the fresh bruise. Pigments may spread closer to the overlying translucent skin thus becoming visible on the surface a few days after injury.

DEGREE OF FORCE

Skin has greater elastic limit than underlying fat and blood vessels making subcutaneous bruising more common than skin laceration. Degree of force cannot be accurately deduced from the size of a bruise. Although heavy impact will generally cause a large bruise, severity of bruising depends on:

(1) Anatomical site: over bony prominence (shin, cheeks), lax, vascular tissue (eyelid, orbit) fatty tissue (buttocks) will bruise easily. Escaped blood has room to accumulate in lax tissues. Resilient muscle of anterior abdominal wall rarely bruises (although there may be severe underlying visceral injury). Dense, tightly bound tissue, e.g. palms, soles, rarely bruises. Dense fibrous tissue physically restricts accumulation of blood.

(2) Age

Infants have loose, delicate, fatty tissues which bruise easily. Elderly: degeneration of vessels and connective tissue allows easy bruising

(3) Obesity & Sex

Obese individuals bruise more easily than lean due to a greater proportion of subcutaneous fat Females generally bruise more easily due having a greater proportion of subcutaneous fat than males

(4) Disease of clotting

"spontaneous" bruising (haemophilia, leukaemia and platelet disorders), some infections (meningitis), liver disease ( including alcoholism), vitamin C deficiency (scurvey), poor nutrition, medications

(5) Skin colour black skin may mask bruising. UV light needed.

AGE AND COLOUR CHANGE IN BRUISES

-immediately DARK RED (the colour of capillary blood)

-soon turns DUSKY PURPLE

-subsequent colour changes very variable in timing and result from HAEMOLYSIS by enzymes and cellular products.

Colour changes begin at the periphery and progress towards centre if large. Smaller bruises may change colour uniformly. Pigments, including bilirubin and haemosiderin are released from haemoglobin within degenerating red blod cells

Subsequent colour changes:

1. BROWN

2. GREEN 4-5 days or more

3. YELLOW 7-10 days or more

4. STRAW

5. DISAPPEARS 14-15 days (range 1-4 weeks)

A small bruise in a healthy adult may disappear in 1 week. A love bite (Hickey) may vanish in 2 or 3 days.

N.B. The time course is very variable time course depends on adequacy of lymphatic and venous drainage, size and depth of bruise, anatomical site, age of person (v. slow in elderly) and general health Accurate dating of an individual bruise is difficult. Distinguishing FRESH from OLD is easier and often important, e.g. repeated assault, child abuse

POST MORTEM LIVIDITY (hypostasis, livor mortis) The settling of blood into the lowermost blood vessels under gravity after the circulation ceases. Results in a pinkish discolouration of the skin in the dependent parts of the body. Blood vessels compressed by pressure of contact with clothing or supporting surface will not fill and the area remains pale (contact or pressure pallor). Lividity is sometimes confused with bruising. Distribution and pallor help to discriminate. Incision of the skin shows oozing of blood from cut, engorged vessels which can be rinsed away in lividity. Incision of a bruise reveals escape of blood into the tissues which cannot be rinsed away. Escape of blood cells and haemolytic pigments from vessels into the surrounding tissues due to putrefactive breakdown may be difficult to distinguish from bruising.

 

There are such kinds of bruises: bruise, haematoma, petechiae and ecchymosis. The own  bruises are superficial and deep. Superficial bruises loud already after 20-30 min after trauma, and their intensity and dimensions augment while blood outpours. Deep effusions of blood at first do not look over the skin and into  first 2-3 days after trauma can not to appear.

Haematoma is the limited deposit of blood in tissues, that some heaves up skin or mucous envelope and shapes for tissue layers moving apart counting whether organs thickness. 

Petechiae are the shallow, like-drop, round shape effusions of blood of red colour into skin whether mucous envelope.

Ecchymosis are more large, limited, non-shapeed hemorrhage of red colour into  skin, serose whether mucous layers.

The size of bruises is different - from small ("dropped") to extraordinarily spacious, that occupy one or more part of body.

Shape of the bruises  can be various, but the most often oval whether round with clear edges, specially in fresh cases.

Like-ribbon bruises, specially looped, are the result of blows by cord, strap whether other object, shapeed in loop appearance.  

In majority of cases the bruises do not have some definite shape.

Elementary bruise colour is always crimson or dark blue. In process of time  its colour changes, bruise, as the saying is, "flowers".

In bruise place on skin whether mucous envelope no traces usually does not remain, but sometimes during some time on skin is kept dark pigmentation. 

Effusions of blood into connecting eyes envelope,  into skin, sometimes into transitional lips part, ordinary resolve without discolouration crimson,  gradually diminishing in intensity and dimensions.

POST-MORTEM BRUISING can occur but needs great force to produce small bruise. After death blood is under physical pressure only. There is only a passive ooze from blood vessels ruptured after death rather than the active extravasation under pressure which occurs in life. Most likely to occur within areas of post mortem lividity where blood is under greater physical pressure and over bony prominences where tissues may be crushed against the underlying bone, e.g. back of the head.

SHAPE AND SIZE of bruises are very variable & poor indicator of causative object. Expansion and movement blur the outline. Some bruises inflicted with a small hard object, immediately prior to death may retain the pattern of the causative object. Rapid death will limit the extension and blurring of the outline which usually occurs under circulatory blood pressure. e.g. bumper, grille or headlight on pedestrian, neck ligature, blow over clothing or jewellery An associated imprint abrasion is more useful.

CLASSICAL PATTERNS OF BRUISING

Patterned Intradermal bruise due to impact with a hard, patterned object with ridges/grooves. Skin over ridges is compressed and vessels remain intact. Skin forced into grooves and dermal vessels ruptured. The resulting accumulation of a small amount of blood, near the epidermis may demonstrate the obvious pattern of the causal surface (tyre, shoe tread, car bumper, clothing, gun muzzle) It is often useful to trace the outline onto an acetate sheet for later comparison.

Finger pad bruises are round or oval, slightly larger than the finger tips due to outward spread of blood. Due to gripping by fingertips in forceful restraint Found on -limbs and face (child abuse), thighs (rape), neck (throttling (manual strangulation)), arms (forceful restraint or post mortem movement of the body

Tramline bruising due to a rod shaped weapon or stick. Compression of vessels centrally, not usually damaged unless crushed onto bone. Traction causes rupture of vessels along edges of rod. A solid stick bruise is limited to the convexity of the body surface (remember that a soft body part such as a buttock will mould and flatten. A flexible strap or flex willwrap around the convexity producing a longer and often curved tramline bruise.

Doughnut bruise due to a spherical object (cricket ball)

Love bite (hickey) Not a bite. No teeth marks. Suction bruise caused by firm application of the lips against the skin, forming an air-tight seal, oral suction causing a shower of petechial bruises from rupture of numerous small vessels. Normally found on teenagers after the weekend! Also seen on neck, breasts in sexual assault. Must be human in origin. A similar appearance is seen

between the dental arches of a true bite.

Counter pressure bruises of bony prominences of shoulder blades, sacrum and back due to forceful restraint against wall/ground. More common in muscles than skin.

Black eye (peri-orbital haematoma) fist blow to orbit fractured skull (R.T.A., gunshot) tracking from forehead bruise.

Punching is directed at the upper body , especially the face Causes bruising, abrasion, laceration over bony prominences and teeth, fractured nose & face. Bruising or abrasion of knuckles due to throwing punches

Kicking (or shod foot assault)

Stamping, jumping may reproduce the pattern of the sole Glancing kick may cause a scuffed abrasion Direct blow (swinging kick) may result in bruising, laceration or a curved imprint abrasion Typical target sites: face, neck, loin, groin, back, chest. Associated internal injury is often severe

Bruising of Various ages: suggests repeated assaults (child abuse, wife/husband beating, elderly (beating or poor balance), alcoholics

Medical interventi  on

-sternal and cardiac bruising

-bruising around needle puncture marks

-pinching skin to test conscious level (butterfly bruise)

N.B. Bruising usually due to Accident or assault; it is rarely self-inflicted (too painful and unimpressive!)

 

Forensic significance of bruises

*    This is the sign of violence

*    It suggests the action of blunt object

*    It suggests the site of external impact

*    Identification of object

*    Kind of violence

*    Time of injury

*    Degree of violence

 

Lacerations (wounds, vulnare)

 

Wounds. They refer (legal definition) to the rupture of the full thickness of the skin (or the lining of a lip). This excludes abrasions, bruises, internal injuries and fractures. Medical definition: disruption of the whole continuity of the tissues produced by external mechanical force. As against an abrasion and bruise a wound heals with scar formation. There are different types of wounds depending on the manner of applied traumatic force: stab wounds, incised wounds, firearm wounds etc. Wounds in which the skin and underlying tissues are torn as a result of blunt force application are termed as lacerations.

 

Wound healing process.  Complex series of events controlled by chemical mediators, the function of which is to remove harmful microorganisms and necrotic tissue, to defend against any further injury and to replace injured cells and restore architecture and function. Arteriolar and capillary bed dilatation cause blood flow to be massively increased in the injured area, and vascular permeability is increased resulting in the formation of an extracellular, protein-rich inflammatory exudates (Kumar et al 2005 pp.49-62; Alpar and Gosling 1999 p.42) video  . Vascular permeability is modulated by kinins, complement and coagulation cascades. White blood cells, predominantly neutrophils, adhere to the vascular endothelium due to the expression of adhesion molecules and migrate to the site of injury under chemotactic influence. Neutrophils are phagocytic, and attempt to clear the wound of invading microorganisms and cell debris. Monocytes infiltrate the injured area and differentiate into tissue macrophages – scavengers of necrotic tissue and bacterial remnants etc. They also stimulate the growth of endothelial, epithelial and fibroblastic cells via growth factors video  . 

 

General morphological characteristics of lacerations:

·     various shapes and differ in sizes

·     edges are ragged irregularly and bruised

·     margins are commonly abraded (abraded area corresponds to that of the impacting surface)

·     tissue bridges in depth of wound (intact nerves, vessels, tendons)

·     ends are ruptured sometimes pointed

·     foreign materials are usually observed

·     external bleeding is mild

A definite kind of blunt objects inflicts laceration with defi­nite (typical) medicolegal characteristics. These morphological features help to identify a causative object during forensic medi­cal examination of the victim. Forensic medical expert must know them perfectly.

Typical morphological appearances of lacerations. 1. Wounds caused by the objects with flat prevalent surface: a treelike shape, an oval abrasion in the center of the wound, abraded area corresponds to that impacting surface. 2. Flat limited surface: small size (3-5 sm.), a star-like or H,T,Y,X-like shape, abraded area stamps reproduction of the traumatic surface. 3.Spherical surface. Such objects inflict lacerations which are characterized by 4 main signs: star-like shape, oval or circular abrasion around the wound, plate-like hole and tissue defect in the centre of the wound. 4. Cylindrical surface: fissure-like shape, strip-like abraded margins, two ruptures in each end. 5. Dihedral corner: a fissure-like shape, regular and not abraded margins, pointed ends. 6. Trihedral corner: star-like shape, small abrasion and pyramidal hole in the centre.

Forensic significance of lacerations:

·     Their appearance suggests a blunt force application;

·     Typical morphological features of lacerations help in iden­tification of the used object;

·     Time of the injury can be determined according to the healing process in the wound;

·     Rarely self-inflicted.

Interpretation of wounds. Causative object or weapon: An imprint abrasion from a direct impact with patterned surface. Trace material in a sliding abrasion, laceration. Order of Infliction: Tentative or scattered first, fatal or grouped later. Manner of infliction: by assessment of circumstances, scene of death, pattern of injuries as a whole.

Self-inflicted wounds. Blunt force injuries are rarely self-inflicted. One or two potentially fatal. Scars from previous attempts. More than one method tried.

Assault: Any type of a wound (laceration, incision, stab, gunshot) frequently in combination. Punching — directed at the upper parts of the body , especially the face. It causes bruising, abrasion, laceration over bony prominences and teeth and fractures of the nose of facial bones. Kicking-stamping, jumping ® the pattern of a sole, glancing kick ® scuffed abrasion, direct blow ® bruising, laceration. A curved imprint abrasion can also be seen on the following sites: face, neck, loin, groin, back, chest. The associated internal injury is often severe.

Defense injuriesa pattern of injuries sustained by taking protective action against an anticipated trauma (accidental or assault). A victim is known to be conscious, not completely surprised by an attack and at least partly mobile. Typically seen on hands and forearms. Bruises, abrasions, incisions, stabs, gunshots. Secondary injuries due to falls onto nearby objects. The absence of injuries doesn’t exclude assault.

Accidental: Any type of wound, any site, usually single. Clothing is involved, defence and secondary injuries are common.

 

Laceration From Lati  n l acerare- to tear. Botanical term- irregular edges Defn. Full thickness tearing of skin or tissue due to stretching and crushing by blunt force Characteristics: Ragged edge, Associated bruising/abrasion, Tissue bridges Provides little specific information about the causal object

 Lacerations are wounds in which the skin and underlying tissues are torn as a result of blunt forces application.

 

Laceration

 

BLUNT FORCE TRAUMA by moving object or fall. Pinning, crushing and stretching forces result in splitting and tearing of tissues. Same type of trauma which causes bruising and abrasion but full thickness injury Typically over BONY PROMINENCES where tissue is pinned and crushed against underlying bone, e.g. scalp, eyebrow, cheek, shin A single blow may cause more than one laceration Soft tissue areas of limbs may be lacerated by a blunt projecting object which pulls obliquely  against the tension of the skin causing stretching and tearing.

Rolling/grinding movement of vehicle wheel strips and tears

Lacerations are characterised by:

1). Ragged edges (torn apart), bulging fat, crushed hair bulbs

2). Associated Bruising and Abrasion of skin edges and adjacent tissue (BFT)

3). Tissue Bridges in depth of wound (intact nerves, vessels, tendons)

A tangential component may give one clean-cut edge, other ragged, undercut or flap-like.

Typical signs of lacerations are following:

*   various shape and different their size;

*   their edges are  unequal, frequently crushed, sometimes thin;

*   on wounds edges almost always epidermis is fleeced on different width, and sometimes - even of concrete shape;

*   vascular, hair (on head) or connecting-tissue membranes between contrary edges, most often in wounds ends;

   the wounds ends are rounded, blunt, with slights tear, sometimes can be sharp.

This is the general (group) wounds signs from blunt objects, because they meet attached to injuries by different blunt objects, irrespective of their specific properties.

There are also specific morphological signs from the action of concrete blunt objects which are  directly correspondented in their classification.

1.The wounds from action of blunt objects with flat prevalent surface, as a rule, have a branchy whether sinuous shape zigzag, sometimes with ramifications; thr edges are  teared, with numerous slights tears.

2.From action of blunt object with flat limited surface are generated the small wounds in majority of cases  (3-6 cm), Ã-, Ò-, Í-, Ó-, Õ-identical shape, radiant,  and scratching of skin round whether in their boundary paths frequently reflects a shape and size of striking object surface (or its part): round, square, rectangular, arched, in appearance of open corner, etc.

 

typical laceration

3.Spherical surface of blunt object omits the wounds radiant for shape  (3-5 rays and more); fleecing of epidermis in them round whether oval shape; central part of wounds is saucer- whether watering-can-like deep-laid, in centre – considerably - crushed, thin, up to shapeation of defect of three-cornered whether indeterminate shape, as a result of some abbreviation of injuryd tissue.

4.The objects with cylindrical surface usually cause the chinky oblong, wounds,  and wound longitude always accords with object landmark into blow moment.

 

 

Laceration caused by cylindrical instrument

 

5.The wounds from action of object  with trihedral corner have a radiant shape (but there can’t be present more, than 3 rays), sometimes pyramidal in centre, scratching in them three-cornered shape and disposed in central part.

6.A blunt object with rib drifts the chinky wounds,  edges of which in point of equal, sinuous, scratched in appearance of narrow stripe, locally fleecing of epidermis can stay outed.

The blunt objects can bring on injury of skin, in shapeation mechanism of which tension prevails,  them mark as cracks, slights tear, breaks and tearing off.

The injuries from tension have typical properties. They’re linear, with the shape of spindle, dispose by groups, ends in them are sharp, and equal edges,  by what remind of injury from sharp objects. Ripping of edges in such wounds is absent. The cracks, slights tear whether breaks in groups usually are identically competent, disposed in-parallel one to one.

 

INTERPRETATION OF WOUNDS

(1) Causative object or weapon

Imprint abrasion from direct impact with patterned surface

Trace material in sliding abrasion, laceration

Stab may indicate shape, width, length of instrument

(2) Order of Infliction

Tentative or scattered FIRST

Fatal or grouped LATER

Distant shots before close shots

(3) Manner of infliction

By assessment of Circumstances, Scene of death, Pattern of injuries as a whole

SELF-INFLICTED:

Gunshot wounds and ncised or stabbed wounds with sharp or pointed object. are preferred

Blunt force injuries are rarely self-inflicted.

Accessible target sites (often unilateral with "handedness") e.g. incisions to wrists, cubital fossae, neck, groins stabs to chest (precordium), abdomen (epigastrium) shots to mouth, temple, heart

Clothes drawn aside

Multiple, Shallow, Tentative "Hesitation wounds" e.g. incisions to wrist and neck stabs to chest and abdomen

Closely grouped, Parallel, Same Direction e.g ."sawed" incision in same track stabs at same angle partial withdrawal and reinsertion

One or two potentially fatal

Scars from previous attempts

More than one method tried

ASSAULT:

Any type of wound (abrasion, bruise, laceration, incision, stab, gunshot) frequently in combination

Punching -directed at upper body , especially the face. Causes bruising, abrasion, laceration over bony prominences and teeth and fractures of nose of facial bones

Kicking-stamping, jumping --> pattern of sole glancing kick --> scuffed abrasion direct blow --> bruising, laceration. May also see a curved imprint abrasion

Sites: face, neck, loin, groin, back, chest.

Associated internal injury is often severe

Sharp force is favoured -stabs & incisions

- Any site - often inaccessible to victim, e.g. back!

- Usually multiple

- Wounds aimed at vital area but scattered and grouped

A single wound suggests the victim was sleeping, drunk, drugged or incapacitated. The single wound is usually targeted (stab to heart, shot to head)

- Lack the unhurried site of election - no time to chose

- Inflicted through clothes

- More uniform force

- Multiple directions e.g. of incisions or stabs

- Several may be potentially fatal

- Associated defence injuries

Defence injuries- a pattern of injuries sustained by taking protective action against anticipated trauma (accidental or assault). Indicates that victim was conscious, not completely suprised by attack and at least partly mobile.

Typically seen on hands and forearms.

Bruises, abrasions, incisions, stabs, gunshots

Absence does not exclude assault (surprised)

Secondary injuries due to falls onto nearby objects

ACCIDENTAL

Any type of wound, any site, usually single

Clothing involved, defence and secondary injuries common.

Forensic significance  of  wounds

 

CLINICAL IMPORTANCE

Often little external blood loss (except scalp) due to crushing and retraction of vessels.

Associated internal injury/bleeding. Wound infection frequent (F.B.).Heals by scarring

FORENSIC IMPORTANCE

1. Shape and size not usually related to causal object

2. Trace evidence in wound (F.B.)

3. Rarely self-inflicted

EXAMPLES

Crescentic/circular ... round-headed hammer

Y-shaped ... metal rod

Inside lips (trauma against teeth) ... blow to mouth

Flaying laceration ... rolling/stretching of skin over limb in R.T.A.

Perineum ... rape

Stellate ... heavy vertical blow.

 

Fractures (fracturae)

 

Fractures is called a full or partial violation of bone whether cartilage safety, a result of fast-acting considerable force, as a rule, are generated attached to action on bone of blunt object and beginnings by reason of it such deshapeation appearances:  bend,  thrust (cut), tension, compression whether twisting. The fractures arise as in force application place (in tie with what are called local), so and on distance from it (remote fractures). Contradistinguish full and incomplete, lonely and numerous, open and cover, linear and splintered fractures.

In forensic-medical practice often meet and are in great importance the skull bone,  long finitenesses bone and ribs fractures.

Skull bone fractures.  The local skull fractures shape into time of immediate contact of blunt object with skull. The prevalent surface of blunt object causes splintered  fracture in appearance of constrained or flat allotment, by size 40-80 cm2 and more, round whether oval shape.

 

 

Fracture of the skull

 

From blow by flat limited surface of blunt object in skull bone are generated the pressed or perfprated fractures, which for size and shape totally whether partially reproduce the contours of surface.

 

Fracture caused by flat limited surface

 

The Objects with spheral surface in typical cases cause the small pressed skull vault bone fractures, rounded by circulation crack, with falling back of separate pieces and shapeation of dip, which reminds the part of sphere.

Very typical fractures remain from action of the objects  with trihedral corner: unreserved, pressed fractures of three-cornered shape (on vault surface ) in appearance of trihedral pyramid, a top of which is directed in skull.

The blunt objects with rib (by whether dihedral corner) in skull bone shape pressed, oblong fracture which has some peculiarities. From ribbing action arises long crack with split off edges in external osseous plate, in-parallel to it and on some distance from it shape still two some arched cracks with equal, plumb edges. 

The similar fractures cause the blunt objects with cylindrical surface.

The remote skull fractures arise far from application place of great force and appear in most cases attached to compression of skull or attached to blow by blunt object with wide contiguity surface.  

Attached to flating, general skull deshapeation,  when a troupe head aqcuire unusual to it appearance and shape, that frequently is observed attached ïåðå¿çä³ on the strength of it transport object, to define these types of crack under dissection time impossibly.

 

Fractures of long finitenesses bone.  In most cases the fractures of long tubular bone arise from bend deshapeation and twisting, more seldom – from deshapeation (cut) of thrusting .

In ordered to find concrete fracture properties attached to corpse dissection injuryd bone and all of its fragments must be taken out, to modeled, to dried out and to glued together.

Other frequent kind of deshapeation of long bone is its fracture as a result of rotation or twisting, attached to which a fracture shapes spiral. 

For torsion fracture is typical one whether several screw lines,  which envelop several bone surfaces in direction of twisting and which go under corner  about 45° to bone  landmark. 

The ribs fractures are local and remote. The local fractures are generated in local outward on breasts. The rib whether group of contiguous ribs in force application place sags inside of thoracic cavity. An internal ribbing plate exposes to tension, and external - to compression. On internal ribbing surface the fracture ordinary gapes, it line and edges clear, some wavy, plumb.

In external ribbing plate,  where prevail compression forces,  fracture line also transversal whether slanting and transversal, but zigzag, thinly - rectilinear, in row of cases with oblong cracks. Edges of fracture are unequal,  toothed, rumpled, split off, pressed, sometimes elevated, lay one on another like tile ("peak"), sometimes is generated billowed concentration of compact layer.

Remote ribs fractures are generated on considerable distance from application place of external effort to breasts , that typically for squeezing of thorax. Attached to it  natural ribbing curve augments, an external its plate stretches and brokes first, internal - suffers compression. 

 

Injuries of internal organs

 

 A.I. Muchanov (1988) picks out such types of injuries of internal organs.

Slaughter (contusion) is injury in appearance of effusions of blood of different localization by reason of violation of parenchyma organ  safety attached to uncrippled capsule video  . Crack is linear superficial sinuous  injury of capsule of parenchymal organ and thin layer of its parenchyma. Tear is more deep, but in case of compression of edges also linear injury, which does not arrive at organ middle. Break is more deep injury; may be incomplete, when parts of organ are joint by capsule and thin layer of parenchyma (less 1/4 of general organ thickness), and full, when an organ is parted totally or between its parts remained only capsule pieces.  Tearing off is a full compartment of internal organ by reason of breaks its fixative tie, vessels and crushing,  etc. Crushing is the destruction of the part of internal organ with transshapeation of its tissue into pappy mass or into a lot of shallow deshapeed morsels.

Contradistinguish the local and remote injuries of internal organs.

Ruptures of the liver

 

ASSOCIATED INTERNAL INJURIES

Surface wounds may be informative but are often simply the trivial markers of lethal underlying

injury.

Head injury (separate lecture notes) by fall, blow or RTA Head is heavy, mobile and unstable. Scalp bruising and laceration common over bone.

Skull deformed by impact. If excessive skull may fracture at the site of impact: linear, radiating, depressed, hinge, ring, contre-coup. Injury to blood vessels and brain may occur without overlying fracture.

Analagy: blancmange (brain), wrapped in cling film (arachnoid), in paper bag (dura), inside a cardboard box (skull), wrapped in brown paper (scalp). Any layer may be damaged by impact (blow) or dropping (fall)

Intracranial haemorrhage often follows head injury:

Extradural- fracture tears artery~

- easily overlooked (concussion, lucid, coma)

- immediate or delayed accumulation of blood

- causes pressure on brain

- amenable to surgical decompression

Subdural - common in elderly, children, alcoholics

- small bridging veins torn by trivial impact or rotation

- may remain asymptomatic, partially healed and an incidental finding at autopsy

Subarachnoid- natural (aneurysm rupture) or traumatic,

-ass. with contusion, laceration of brain or blow to side of neck often rapidly fatal

Brain injury

-may occur without fracture or intracranial haemorrhage

-rotation & accel/decel. injury more damaging than direct impact against the fixed, immobile head

-blow accelerates the head causing contusion at the point of impact (coup contusion)

-fall decelerates the head causing more obvious contusion at the diametrically opposite point (contre-coup) contusion where the brain glides over the irregular, jagged contours of the skull.

Analogy is box of jelly

Coup= Kick (head is accelerated)

Contre-coup= Dropping the box (all contents decelerated)

Typically a backward fall striking the back of the head (occiput) on the ground causes scalp abrasion, bruising or laceration with localised coup contusion at the occipital pole and more marked contre-coup contusion over the frontal and temporal poles where skull surface is rough. May also occur in a fall onto one side but not after a forward fall. Greater force may lacerate the brain

Deep intracerebral haemorrhage may occur Widespread subtle microscopic nerve fibre (Diffuse Axonal Injury)injury is common due to shearing stress of rotational impact or deceleration Analogy is shaking or kicking a TV set Associated swelling (cerebral oedema) is often fatal by raising the pressure within the cranial cavity (raised ICP) squeezing and damaging vital structures.

Facial injury

-accidents (RTA)

-assault by punch, kick, blunt weapon

-fragile facial bones susceptible to injury

-bleeding into nose, mouth and sinuses often profuse, may obstruct air passages.

Neck injury

-vulnerable area, access to vital structures such as the trachea, large vessels (carotid arteries, jugular veins)

-sensitive major nervous conections and reflexes

-cervical spine and spinal cord

-incisions, stabs, blows and pressure very dangerous (air embolism)

Chest injury

-heart, major blood vessels and lungs vulmerable to impact, compression and penetration

-blunt impact of RTA is common multiple rib's prevent respiration pneumothorax, lacerated lung, heart.

-lacerated aorta due to deceleration

-site of election for stab and gunshot wounds with profuse haemorrhage into pericardial sac or pleural cavities

Abdominal injury

-Abdominal skin injury is rarely seen, particularly if impact is over a broad area

-Liver, spleen, kidneys, intestines are vulnerable to compression and laceration against the spine following the blunt impact of RTA or assault

-Site of election for stab wounds with penetration of vascular organs such as liver, spleen, kidney, mesentery or major vessels such as aorta, vena cava with severe blood loss into the peritoneal cavity

-Peritonitis may follow intestinal damage.

Limb injuries

Common in many accidents (RTA), falls, assaults

Fracture (= a disruption in the continuity of a bone)

Result of direct or indirect force,

may be complete or incomplete

closed (simple) or open (compound)

transverse, longitudinal, oblique, spiral

comminuted (more than 2 fragments)

compression  of spine, 5th metacarpal (boxer's )

depressed  of skull

stress  pathological  in weakened, diseased bone (osteoporosis, malignancy)

Fat embolism clusters of fat cells escape from within the central marrow cavity of a fractured bone or subcutaneous fat and enter the circulation via veins. Become entrapped in the small vessels (mainly capillaries) of the lungs or may pass through the lungs to block the capillaries of the brain, kidneys, heart and elsewhere. Pyrexia, skin rash, coma, renal failure. May be fatal.

 

 

FALL-RELATED INJURIES

Fall-related injuries. There are 3 types of falling:

·     fall from a height equal to a person’s height (fall on a flat surface)

·     fall from a height of 2,3-10 m.

·     fall from a great height (more than 10 m.)

Fall on a flat surface. It is typical for alcohol poisoning and it occurs in standing position usually. Victim falls down backwards and strikes his head to the ground. This results in fissured fracture of the occipital bone and fatal areas of coup and contra coup injuries of the brain can be revealed during forensic autopsy.

Fall from a height of 2,3-10 m. The morphological appearance in such cases allows to determining the impacted part of the body. But there are some signs which are common in this case: injuries are located at the site of a direct impact; bone fractures are often symmetrical; internal injuries are prevalent in relation to external damages; presence of the signs of general concussion of the body — massive hemorrhages in fixing apparatus of parenchymatous organs (lungs, liver, kidneys, spleen etc.)

Fall from a great height is characterized by the same features, but all the injuries are usually severe and massive.

Properties and heaviness of injuries depend on height of fall, body mass,  peculiarities of the surface on which body bumps,  from body allotments,  on which  blow was taken, from that, whether was fall straight whether successive, and from other factors.

 Pick out three man fall variants:

*                   fall on plane or from height of own growth, under man motion time by step, attached to fast walking, running;

*                   fall from some metres and some ten of metres: from houses windows,  into shoots clear space,  from balconies, multistory buildings, bridges, from trees, etc;

*                   fall from bumper height (ten and hundreds metres ).

Fall on plane can happen from stand-up regulation, attached to walking or running.

Attached to fall on one's back arises a typical injury  -  a crack of cervical bone, which is directed to big cervical hole, sometimes avoids it on skull base and reaches the pyramids.

 

 

Fracture of the skull due to falling down

 

Fall on plane from height of own growth  is a typical  trauma of persons in state of alcoholic intoxication.

Fall attached to fast motion, to running can be met while escaping from pursuers, catching somebody, attached to employment by sport as accidental trauma.

Attached to fall from height of a little metres the injuries depend on that, on which body surface disappointed man. From fall on trilbies arise the shins bone fractures,  reams, less frequent - thighs, traumatize the heel bone, happen the circular skull base bone fractures.  Attached to fall on back the shoulder blades and spine fractures may be often found. Attached to fall on hands and knees are generated the symmetric forearm bone fractures in allotment of carpo-radial joints, fractures of thigh-bone, sometimes   patella’s. The circular skull base bone fractures are observed attached to fall on sinciput or seats.

Attached to fall from height of few ten metres arise the same injuries such,  but they’re more vast whether massive. Fall from height 20-25 m and more, as a rule, mortal.

Attached to fall on head the injuries are disposed on one its surface. Presence of some injuries and on different, specially contrary head surfaces  witnesses that they happened from other reson, and, possibly, from action of outsider hand, before fall of body from height.

        So-and-so,  the typical general fall signs from great height are: disparity of external injuries to internal attached to considerable dominance last, numerous signs of general body shock (multilocal, spotty effusions of blood into fixative vehicle of internal organs, their intercourses, gates, are reproached; parallel cracks disposition, tears whether breaks of parenchymal organs), as a rule, one-sided, injuries localization.

Also attached to fall on trilbies are the symmetric multisplinter fractures of heel bones, tarsus fractures with deshapeation of talocrural joints, are tired out the fractures of crural bone, fractures of thigh-bone neck and hollows of coxae joints, pelvis, fractures of the vertebrae bodies from compression, sometimes - annular skull base bone fractures.  Attached to fall on seat arise the fractures of pelvis bones, compressial vertebrae bodies fractures,  less frequent - annular skull base bone fractures.  A fall on head forwards by  multisplinter skull vault bone fractures,  typical for action of blunt object with prevalent surface. Attached to such fall arise also the compressial and splinter spine fractures,  specially jugular its department, sternum and ribsfractures. Least injuries shapes attached to flat fall, because blow force divides on considerable plane.

 

Morphological appearances of injuries caused before death

 

If from wound moment passed few days or hours, then settlement of question as to the supravitality of trauma origin does not bring on difficulties. Considerably difficult, and sometimes impossibly to solve a question when injury happened in agony period or just after coming in death.

Injury supravitality (or trauma is supravital) - injury, which grew up in living man. The signs of supravital injuries origin are:

   considerable external whether internal bleeding indicating on activity the hearts;

   general expressed corpse anaemia, Minakov’s blot:

   vertical blood streams on cloths whether body and blood sparks on ambient objects;

   aspiration and swallowing of blood attached to neck organs wound,  skull base bone fractures;

   finding of blood in urinary bladder attached to its safety and injury of kidneys;

   parenchymal-cellular, osseous whether air, fatty embolism of lungs and heart, thrombosis of shallow vessels;

   retraction (abbreviation) of tissues in wound allotment,  abbreviation of muscles like humps attached to dismemberment of body;

   thick blood thrombs, effusions of blood into soft tissues in injuries allotment;

 

Ante-mortem bruise

 

   presence ardently-proliferative processes in tissues;

   traumatic (inflammatory) oedema;

   finding erythrocytes and cells, containing hemosyderine, in the regional lymphatic glands, etc.

All of phenomena, which give a possibility to set injuries supravitality,  one can be divided on general taxis and local changes.

Injury, which grew up post mortem, can be accidental and intentional. Accidental posthumous injuries sometimes arise attached to irregular troupe transport,  attached to unskilled assignment of medicare to the patient who died. Aforethought posthumous injuries can blow in killer to the dead with vengeance, attached to dramatization of accident, simulating of suicide, attached to criminal troupe dismemberment.  Posthumous are the injuries, associated with necropsy,  his artificial conservation.

Injury remoteness is the time, which passed from the moment of the infliction of trauma to human till its examination by doctor or till  deaths.

 It is important to set: whether death is due to trauma or not,  whether it was done just before the death, when exactly the trauma was done.

Injuries remoteness is determined by bruises colour,  skin temperature changes in their disposition places, by the dynamics of the reactively-proliferative processes attached to bruises or wounds cicatrization and  scars shapeing .

The bone fractures dates are established due to the development degree of the callosity. A fracture accretion duration depends upon the kind of the broken bone .

SURVIVAL TIME AND ACTING CAPABILITY AFTER WOUNDING

Post-injury survival time is important in reconstructing events

How long did the victim survive?

Was the victim still capable of fighting, resisting or fleeing?

Some injuries are incompatible with any significant survival, however fit or young the victim.

Destruction of the brainstem or arch of aorta cause almost instantaneous loss of consciousness and rapid death.

Multiplicity of wounds and involvement of the heart and brain are associated with a short postinjury survival period. The effects of injury to major nerves, muscles and joints, followed by bleeding and shock will ultimately incapacitate the victim. The time taken to do so, and what actions are still possible is very difficult to estimate. A suprising amount of activity is often reported following infliction of an obviously lethal injury. Many remarkable examples in the literature. Levy & Rao suggest that overall, 71% of stab wound victims and 49% of gunshot victims survive at least 5 minutes. The victim may not be aware of the injury initially. Pain is suppressed by the adrenaline response of "fight or flight" and vigorous activity may be maintained for a period of up to a few minutes when the will exists. Such activity will cease when physical factors such as blood loss lead to immobility, loss of consciousness or death.

Main effects of injury are bleeding and shock. Will ultimately incapacitate the victim. The time taken to do so, and what actions are still possible is very difficult to estimate. Activity varies from staggering a few paces to running considerable distances or up flights of stairs. Estimation of survival period is almost impossible. Numerous variables exist. Fit young adult will survive longer and be capable of greater activity than an elderly, infirm individual. Extensive destruction of the frontal cerebral lobes of the brain may permit survival and activity before death occurs from associated brain damage and shock.

 

How to describe the injury

    

An injury of the soft tissue should be described according to the follow order:

1. Localization. This is the location of tissue damage in relation to the topographic anatomical areas of the body (right hypochondrium, left subclavian). Distance, in both vertical and horizontal axes, from the closest anatomical structure or topographic line, for example the navel or left anterior axillary, should also be measured.

2. Type of the injury. Is described as the definite type of damage of soft tissue, such as: abrasions, scratches, bruises, contusions, hematomas, wounds etc.

3. Shape of the injury. To be able to describe the shape of the injury, it is necessary to define it with a widely understood or geometric shape. For example, a wound may be fissure-like, semicircular, oval, round, «Ò»-, «Y»-, «Í»-, «Õ»-like shaped, star-like, spindle-like etc.

A defined shape of the wound has exclusive importance in clinical and expert diagnostics, as it allows confirmation of the mechanism of the wound’s infliction. For example, cut wounds — are always spindle-like, chopped wounds — as a rule, are fissure-like, and entry fire wounds are normally oval or round.

4. Size. In other words, are the dimensions of the damage, which are two (length and width) when describing abrasions, bruises and contusions; and three (length, width and depth) for wounds and damage of internal organs.

 5. Morphological characteristics of the margins. General outlines of a wound are called the margins of a wound. For example, in an upper midline laparotomy there are two margins, left and right. The ends of the wound are the «junctions» (intersections) of its margins. Therefore, in the example above, there are two ends, upper and lower. The margins can be classified as regular or irregular, displaced, abraded or smooth, bruised or not bruised, with or without bleeding, with or without tears or subcutaneous bridges. The doctor’s description of the margins is crucially important during medico-legal examination, as it allows us to conclude the action of definite traumatic instrument (blunt, cutting, chopping) on the victim. Irregular, bruised, abraded and lacerated margins are normally revealed in injuries caused by blunt instruments. Regular, smooth, without any bruises, abrasions and ruptures margins are typical morphological features of the injuries caused by sharp instrument.

6. Morphological characteristics of the ends. The ends are presented in wounds only. They can be pointed, oval or ruptured, with notches or slight-cuts. Slight-cuts are superficial linear damages of the epidermis. Different depth of the wound (seen in the ends of incision) is called as notch.

7. Bottom of the injury. This includes a color of its surface, bleeding, presence or absence of foreign bodies etc.

 8-9. Morphological characteristics of the surrounding tissues. The state of surrounding tissue is described in these points. Inflammatory changes in the surrounding tissues or soot, tattooing (in firearm wounds) are described then.

10. Other properties. These are usually described in cases of penetrating wounds. With this trauma, an expert must note also direction of wound canal in addition to a detailed description of the wound.

 

 

 

To deduce the correct expert due to properties and injury paculiarities,   to ground an object,  which caused the trauma, shooting injury disposition,  to set thermal whether chemical factor etc., to define a trauma mechanism,  inlife whether posthumously it had happened, remoteness of its origin and to solve sometimes other questions, injuries should be carefully explored, thoroughly and correctly  described.

To determination and describing of injury it is necessary to know: localization, appearance, amount, shape, size, depth, colour, edges properties, walls, bottom, relief, presence and bleeding disposition,  area of disposition on surfaces body, girding cloths, outsider inclusions, cicatrization signs,  other peculiarities (localization one with another, in cases of transport trauma - injuries distance from lower surfaces of reems, etc.).

Injury is marked in accordance with its medical term: abrasion, scratch, a bruise, wound, dislocation, a fracture, crack, broke, crushing, burned, etc.

It is indicated to figure up amount of injuries separately on each its appearance.

Important sense for forensicly-medical diagnistics has a injury shape,  which better for all determine the geometrical figures whether other well-known objects.

Injury size should be measured in only accepted linear measures (centimetres whether millimetres).

The colour is of a great importance right to describing of bruises, scratches, wounds, burn whether freezed surfaces, girding their skins (general redness), different apportionments and particles (contamination, muck, soot, etc.). Colour of blood in wounds depth also can change from chemical influences (e.g., from gun-fire gases).

Should be also explored and described edges, ends, bottom and walls of the injuries. 

Different injuries can be attended with relief change of traumatized allotments: swelling attached to bruise, effusion of blood, coming forward of bone splinters attached to fracture, falling back of allotment of dislocated joint, local enlargement attached to hypodermic muscles break,  pressing into brain attached to sub- whether epidural haematoma, unlinear structure of staggered surface attached to thermal whether chemical burns and etc.

Direction of long landmark of injury on surface whether in point of body or separate organ is in much expert importance, specially for oblong injuries.

The outside inclusions can be found both in injury and around it.

Properties of ambient tissues can be different. Ordinary around injuries there are no changes, sometimes near basic injury one can see additional, sometimes appear different carnage. 

Check off cicatrization signs,  degree of its expression, specially attached to research of scratches, wounds, fractures (for sciagram whether attached to research of corpse), that is in important for diagnistics of trauma origin remoteness.  Investigate and describe other injuries peculiarities attached to their presence. With aim of possibilities expansion and objectivisation of got data expediently to employ immediate stereomicroscopy, sciagraphy of the objects in soft Bucci rays,  method of coloured impresses, photography etc.

 

FORENSIC EXAMINATION OF INJURIES  CAUSED BY SHARP INSTRUMENTS

INCISED WOUNDS

Syn: cuts, slashes From Lati  n i ncidere- to cut into. Surgical term incision with scalpel

Definition: Clean division of the full thickness of skin (or other tissue) under the pressure of a sharp-edged instrument.

An incised wound is LONGER THAN IT IS DEEP due to swipe action.

Instrument is sharp-edged, such as: knife (linear, clean), jagged metal (irregular, jagged), broken glass

CHARACTERISTICS OF AN INCISION~

- clean cut, everted edges

- no tissue bridges or abrasion of margins

- linear or elliptical shape, often gapes

- often deeper at starting end

- jagged if inflicted through loose, folded skin.

Chop wound is a variant of an incision. Has clean-cut edges but an abraded margin due to inversion and friction against the sides of the wide blade on insertion.

FORENSIC IMPORTANCE

Reflect sharp edge, not weapon type

No trace evidence

Profuse external haemorrhage and air embolism

Danger to life depends on site and depth

Incised wounds may be Self-inflicted, assault or accident.

SELF INFLICTED

At sites of election (wrists, neck, cubital fossae, chest, abdomen, groin)

Suicidal cut Throat: tentative incisions (left side of neck if right handed), one or more deep, sweeping cuts, down from the left, across the mid-line, up towards the right ear. Sshallow  deep centrally  shallow. Cut slopes upwards and backwards. Incision isusually through level of thyrohyoid ligament and may be down to spine! Repetitive nicks at the base of the wound (sawing). Bleeding is venous, loss of consciousness is slow. Air embolism may occur.

OTHER SELF-INFLICTED INCISIONS

Fabricated assault - superficial wounds to head, left arm, chest abdomen, thighs.

Parasuicidal mutilation - face, arms, trunk ... low self-esteem

ASSAULT INCISIONS

Compared to suicidal cuts, homicidal cuts:

- lack the unhurried election of site. May be aimed, but many miss.

- lie both higher and lower across neck

- no tentative cuts, all are forceful and deepen rapidly

- no repetition in same track

- slope backwards and downwards

- associated with 'defence injuries' to hands and arms

ACCIDENTAL INCISIONS

- random pattern

- usually single

- often deep and forceful

PENETRATING WOUNDS

(Syn: Stab & Puncture wounds) Puncture is "a small hole made with a sharp point" Definition: Penetrating injuries caused by separation of the skin and soft tissues under the pressure of a sharp or blunt pointed instrument, the greatest dimension being its depth.

ITS DEPTH EXCEEDS ITS LENGTH on the body surface.

Often appear trivial externally (short incision or laceration) BUT often causes internal trauma and haemorrhage.

Caused by thrusting of (or falling onto) 3 types of instrument

(1) Sharp and flat, e.g. knife STAB

(2) Sharp and thin, e.g. needle NEEDLE PUNCTURE

(3) Blunt, long and rigid, e.g. wooden stake, spike, screwdriver, tooth PUNCTURE

WOUND

PENETRATING - passes into but not through organ

PERFORATING OR TRANSFIXING - from Lati  n p erforare, p er-t hrough & f orare- to bore passes through and through an organ

STAB WOUNDS

Descriptors of penetrating wounds

a) Damage to clothing (slashes, stabs through folds, blood flow & drip patterns, trace evidence)

b) Site in relation to anatomical landmarks, midline, heel.

c) Shape

d) Alignment (horizontal, vertical, oblique)

e) Size : length & width with edges opposed

f) Direction :in 3 planes

g) Depth

h) Damage to tissues along track

i) Effects : external & internal haemorrhage, pneumothorax, air embolism

Adequate description may provide vital information about :

1) Type of weapon (c): usually a knife

2) Dimensions of the weapon (e)

3) Taper of blade (e)

4) Movement of knife in wound (c)

5) Direction of thrust (f)

6) Depth of thrust (g)

7) Amount of force used

8) Likely effect on victim (h, i)

WOUND LENGTH

A straight in and out stab wound is slightly shorter than the width of the blade due to stretching of the skin over the point of the knife on insertion and elastic recoil on withdrawal. Wound length and width must be assessed with the edges taped together because the wound is often shortened and widened into an ellipse by skin elasticity (Langer's lines of tension) and underlying muscle tone. Wound length < blade width

(1) stretching of skin over point on insertion and subsequent recoil on withdrawal.

(2) tapered blade not fully inserted

Wound length > blade width when blade does not pass straight in and out - entry and withdrawal at angle.

"Rocking" of knife on withdrawal. Cutting edge extends wound length The best indicator of blade width is the shortest (least rocking), deepest wound (weapon fully inserted)

SHAPE OF WOUND May indicate:

(1)Cross-sectional shape of knife blade e.g. - Double-edged blade --> Slit with two sharp ends

N.B. single edged knife may give similar wound due to clean splitting over blunt end

- Thin, single edge blade --> Triangular slit, one sharp end

- Thick, single-edged blade --> Slit with one sharp and one 'fishtail' end due to stretching & laceration over blunt edge

Stab wounds are typically elliptical with clean cut edges and no bruising or abrasion of margins (incision)

(2) Direction of insertion overhang of upper edge, bevel of lower edge N.B. The direction of the wound track through the tissues is assessed at post mortem, with the body lying flat on its back. The position of the internal organs is different in life, when standing, sitting and breathing.

(3) Movement of instrument on withdrawal

Small change in angle --> notch Twisting --> crescentic wound

WOUND TRACK DEPTH

< length of instrument if not fully inserted

> length of instrument if fully inserted and body surface compressed e.g. abdomen, chest.

A small penknife can perforate heart or abdominal aorta.

DEGREE OF FORCE

Wound depth is a poor indicator of force applied

Pressure required to penetrate is often slight with sharp tipped instrument

Depends on sharpness of point, not of cutting edge. Sharp tip requires little force to penetrate, blunt tip requires greater force.

Speed of weapon's approach (F= 1/2 m v2): quick thrust penetrates skin more easily than slow, sustained pressure

Bony damage is useful indicator of depth and implies significant force

Most resistance offered by CLOTHES AND SKIN

The compressed skin 'gives' suddenly, releasing the energy stored in the compressed skin and tissue (elastic reservoir). Once the skin has been penetrated, the blade slips easily through the underlying muscle, internal organs and uncalcified cartilage, without the need for further application of force.

Analagy is stabbing a melon

Penetration of bone requires considerable force and may break the tip off the weapon.

A quick stab requires less force to penetrate than a slow push.

Forcible insertion may cause imprint abrasion or bruising of skin by the hilt of the knife.

Rare, most often on chest

Remember to consider counter-pressure by victim: falling or running onto instrument. The knife does not need to be supported rigidly if tip is sharp. Considerable force and determination

required to remove knife from clothed body.

EFFECTS OF STABBING

Victim may not initially be aware of injury. There may be little or no external blood loss. Internal blood loss may be profuse and rapidly fatal or slow enough to allow time for medical treatment. Main effect is bleeding. The time taken to incapacitate the victim and what actions are still possible is very difficult to estimate. A stab to the heart may bleed profusely out into the confined space of the pericardium. If pericardial defect is small or does not communicate with the pleural cavity cardiac tamponade may result (200-450ml). Left ventricular wound may partially reseal, resulting in slow blood loss or spontaneous healing. Thin-walled right ventricle less likely. Great vessels do not re-seal. Rate of bleeding from stab wound to the lung depends on the size of vessels cut. Large pulmonary veins & arteries branch outwards from the hilum. Peripheral stab bleeds less and may seal if lung collapses. Pneumothorax may itself be fatal. Cut through bronchus may bleed and obstruct airways.

Abdominal stab may penetrate major vessels, liver or spleen with rapid haemorrhage into the abdominal cavity. Stabbing to the head and face may allow penetration of bone in the region of the eye, nose and temple where bone is relatively thin. Pulmonary air embolism originating in a partially severed jugular vein may be rapidly fatal before much blood is lost. Severing a carotid artery or jugular vein results in rapid exanguination.

The surface of object,  which colliding with body, operates on cloths, cutting, disconnecting or slitting them, is called sharp, and suitable objects sharp. The damages, that are generated from them, compose a damages group by sharp objects. Another words any object, which has sharp edge or sharp end (or that and other together), is termed in forensic medicine as sharp.

Mechanical factors are always combined with the motion of a traumatic instrument on a human body (as in a blow) or on the contrary when a moving body strikes a fixed object or surface (as in a fall). These factors resulting in formation of mechanical injuries on human tissues. Such injuries are so different and first of all depend on mechanism of traumatic action on the body, physical properties of the surface of using traumatic instrument (shape of the object) and its kinetic energy.

So, the object which can cut, puncture or chop human tissues, resulting in definite injuries (incisions, stab or chop wounds ) as medicolegal angle is termed as sharp medicolegally.

There is also the following definition of sharp objects (instruments): they are the objects having a sharp edge or end or their combination. They may incise, penetrate or chop the tissues resulting in wounds with definite particularities.

 

2

Some kinds of sharp instruments

 

The sharp objects are classified differently.

*                   Cutting instruments

*                   Stab instruments

*                   Chopping instruments

 

 

By typical man body damages,  that are generated from action of sharp objects, present dependence on article appearance and of mechanism of his action on cloths contradistinguish cut, chopped, sting-cut wounds. All of they characterize by some signs, inherent for action of certain sharp objects. These wounds signs we name general. They enable to distinguish the wounds, entailed by sharp objects, from wounds, drifted by blunt objects whether shot from fire-arms. But for these signs it is impossible to define appearance of sharp object.

Typical morphological appearances of wounds caused by sharp objects:

   Definite shape: fissure-like, star-like

9_1

   There margins are regular, without tears, bruises and abrasions

22

Regular margins of the wound

 

   pointed ends, sometimes with slight tears

   absence of connective-tissue membranes between the margins

Wound healing (wound repair or age of wound), is an intricate process in which the skin repairs itself after an injury. The classic model of wound healing is divided into four sequential phases: 1. haemostasis, 2. inflammatory, 3. proliferative and 4. remodeling.

Within minutes post-injury platelets (thrombocytes) aggregate at the injury site to form a fibrin clot. This clot acts to control active bleeding (haemostasis). In the inflammatory phase which lasts till 3-4 days after wounding vasodilation and phagocytosis takes place and factors are released that cause the migration and division of cells involved in the proliferative phase. The proliferative phase is characterized by granulation (fibroblasts lay a bed of collagen and fill a defect and produce new capillaries); contraction (wound edges pull together to reduce a defect); epithelialization (crosses moist surface, cell travel about 3 cm. from point of origin in all directions). This phase persists in the wounded tissues from 2 days to 3 weeks. The phase of remodeling starts when 3 weeks after wounding elapse and persists up to 1-2 years. New collagen forms which increases tensile strength to wounds. A scar tissue is formed in 1-3 weeks   video.

 

Injuries caused by cutting instruments

 

The Cutting objects are characterized by blade (ribbing, in which borders, that intersect, converge under sharp corner, besides rib this is still sharpen)  and also light weight (knife, razor, than, plait, piece of glass, tin, sharp edge stone, bone piece and etc.).

Damages formation Mechanism by cutting objects include pressing or impaired part of body and simultaneous object motion on his surface. If to take a sharp razor and few to press by her blade on skin in perpendicular direction, then damage will not happen. But already small motion along lengthwise to landmark will bring on skin cut - will grow up sword-cut. So, in forming mechanism of sword-cut major sense has a blade sliding attached to small pressure. At the same timed, by what pressure and by what longer blade extent,  that most and more deep arise wounds.

From action of cutting object can arise and scratches flesh linear skin damages in appearance of her incisions. The Cutting objects can separate parts of body (concha, nose tip,  sexual member, finger and etc.) in dependence on implement peculiarities and his application.

Bone by cutting objects, as a rule, do not impair. Can cut, for example, the cartilages are larynx, trachea, ribs, intervertebral discs, on bone - to remain incisions whether incisions periosteum. If in wound depth or for her motion meet bone whether cartilages (larynges, front spine surface ), then in tracks obligatorily inquire into amount of incisions on them. This will lend a hand acknowledges to know, how much implement onces went deep into cloths.

We can diagnose action of cutting objects for such specific (whether group) wounds signs:

   their shape are C-like, S-like, Z-like

31

Some shapes of incisions

 and attached to summary edges   linear (in tie with what has only length), and their clear spaces in appearance of overturned triangle. Typical wounds gaping due to skin contractility whether cut muscular fibres;

   the wounds ends have an incision (gradual wound depth underestimation bullock of her centre to the last from boundary paths own skin and epidermis) and (whether) incision (flesh epidermis damage of linear form);

   dominance of wound length over her depth and width. However on neck wound from cutting object can have a considerable depth;

   typical strong bleeding, because cut of the vessels, and do not rive, and that's why do not fall;

   they heal over mostly by first intention and omit the thin linear scars.

As a rule, the wounds from cutting objects localize on open parts of body: on front surface of the neck, on face, in elbow bends, on forearms and brushes.

For deduction about area of motion of cutting object adopt to attention greater wound depth in her beginning and greater amount of flesh incisions in her end. Also at the beginning and in the middle cut transversal disposed hair over wound cuts, in that time as over final part of hair wound inundates whole.

Attached to presence of two sword-cuts, that cutting, asking after sequence of their drawing can be cleared up ëðè rapprochement of edges of these wounds. In such once a first wound will be break off, and the next one - staircase, that bound with abbreviation, divergence of edges.

 

Injuries caused by chopping objects

The Hewing implements characterize by considerable weight, act from sweep and with force go down on injury object perpendicularly whether sloping to surface: mattock, chopper, , spade, sabre and etc.

By reason of action of hewing objects are generated the wounds, which differ by considerable size and depth, to them inherent signs, typical for wounds from sharp objects. By trauma Peculiarity by hewing objects is damage of being subject bone. If under damaged soft cloths not about bone, then such advices can be confused with wounds from other sharp objects, specifically - from cutting.

Among damages by hewing objects in judicially-medical practice more often  meet the damages, that drift by different axe. In ordered to deduce correcting expert in damages researches cases, to have about it conceptions.

Axe – this is a special implement, appointed for felling. There are different kinds of axes: for wood, meat, ice, for combat, huntering etc. Their ordinary weight is near   1400-1800 g, woodchopper - 2200 g.

Morphological characteristics of such wounds  depend on that, which part of it blade collided with body. Several variants of its action are happened .

29

Different variants of chopped wounds formation

By Peers variant is into body (head) deepened only middle part, blades. In that case a wound will be screw-type, attached to summary edges - linear, by length from 3-4 sm, to 8-10 sm, liquid more, with all properties of sharp object. Both. it ends sharp, but plumb, swift, will not be the incisions whether incisions. Can grow up a short epidermo- pressing in one whether both ends of wound.

Second variant is into body (head) steeped a sock or heel. Under this is generated oblong, wound with all action properties of sharp object. One end it according with blade action,  will be sharp with plumb walls, and contrary - bifurcated for counting of two short slights tear, which form from sock wedge ribs action whether heel. Attached of such wound it has Y-shaped form.

Third variant is into body (head) deepened all blade or even axe wedge.  In that case arises big (by length 10-15 ñì),

Classic chopped wound

deep, wound with typical action properties of sharp object. But both equestrian it will be stupid, attached to confronted edges in both ends one can be expressed on two short (0,3-1 ñì) slights tear, that grew up from axe wedge ribs.  Attached of such wound acquires X-shaped form.

Sometimes attached to one blow by axe arises two wounds, parted by allotment of skin. This is observed then, when blows falls down on salient and falling back parts of body (on lime-tree in allotment of optic pit, on breasts in ribs allotment and intercostal interval): in places of osseous appearances are generated the wounds, in falling back places - a skin remains whole.

As a rule, each wound by axe forwards to safety violations of being subject bone. Damage of head bone by hewing objects have its peculiarities. If blade whether linen into bone, it operates as wedge, separate by her its cheeks into sides. In dependence axe immersion depth bullock into bone contradistinguish the, kirve, cuttings.

A cut characterizes by violation of safety of external osseous plate and adjoining to it thin spongy matter. A Kirve is more deep damage, which not seize of all thicknesses: bone. Cutting is damage of all thickness bone with formation oblong, fracture. A cut is full part disseverance of bone whether body (À.².Muhanov, 1988).

Attached to a little blows by axe on head sometimes one can be set a sequence of their drawing. After formation of wound the it edges something go away. If wound happening bullock of second blow, aslope crosses first, then attached to information of edges first advice has appearance of bee-line, and other - zigzag form. The Cracks, which happened attached to second blow, do not cross the cracks, that appeared attached to first blow.

The Blows by axe on finitenesses ordinary forward to fingers disseverances   all brush; the tubular forearm bone whether shin can be quite hacked. On them also one can be found the grind from blade action.

From woodchopper action,  corner of blade of which not lustily sharp (sometimes even few rounded), can arise the wounds, from stupid objects and by rib, because them edges are fleeced with effusions of blood, in ends are observed the separate connecting-tissue membranes. Finding such wound on man body we must diagnosed as such, that grew up from action of stupid object with rib. This, however, will not conflict with that it was drifted, by stupid woodchopper blade or other axe.

Chopped wound can have a place only and other cases. For example, attached to blow by axe under sharp corner to body in pieces wound on one her edge, specifically - on lower pieces, can grow up fleecing from action of stupid part of axe - her cheek, to which a skin presses under wedge dip time into body. To Clamber up the edges of chopped wound are able by rough surfaces of linen attached to immersion into body of all axe wedge,  which considerably moves apart the contrary wound edges.  But such cases meet thinly and compose, , exclusion from regulations.

Axe whether other hewing object ordinary employ for murder and dismemberment of troupe of hammered in man.

 

Injuries caused by stab objects

 

The Prickly objects characterize by light weight, elongated by Norm and presence of sharp end. Damage by prickly objects meet more frequent damages by cutting whether hewing objects. A Distinctive wounds vainglories peculiarity is the small external wound dimensions and considerable their depth, has a place considerable wound depth dominance over dimensions of scin hole. This makes their little loud and lustily dangerous for life..

Deep penetration composes main unsafety of chipped wounds. Internal organs, specifically heart, lungs, liver, stomach, bowels lightly reachable even for short blades, because are found on depth 2,5-4 sm from skin surface and not protected by continuous bone. The Ribs for prickly object usually do not be monkey-chatter, that is why such implements lightly pass into intercostal intervals, and than whether dagger can even cut the ribs, specially it front end or his cartilage.

 

Typical stab wound

Attached to damages by prickly objects ordinary meet the considerable internal bleeding into cavities pleural and abdominal,  into cardiac bag, that is why a long narrow channel and small hole in skin can interfere with effusion of blood outside.

From action of prickly objects are generated the wounds,  sometimes - scratches (for example, by needle end,  nail, blades, edge ), and attached to blow into head whether breasts can arise the hole fractures of flat bone (skull, breast bone, shoulder blades). Localization of chipped wounds is prettily typical: more frequent they meet on breasts, back and stomach, more liquid - on head, neck whether finitenesses.

A fracture Form from prickly objects ordinary reproduces transversal crossing of operating implement. Bone with fractures, called by prickly objects, attached to necropsy withdraval and was kept in quality of clothe proofs or to hand investigation down. That namely bears upon cases, when in wound find the objects,  which stick in bone.

 

 

Such classification of stab objects is used in modern forensic medicine very often (according to A.I.Muhanov, 1964). So, we distinguish such stab objects:

*                   stab objects without edges (nail)

*                   stab objects  with edges (screw);

*                   stab objects with double-bladed flat (nife).

 

A. There are such stab objects without edges: a needle, awl, spoke, tenon, round nail, stylet, rapier, dart and etc., which have on transversal cut a round or oval form. They operate on cloths by its end, by reason of what is generated a point-wound. In dependence on implement diameter the wounds frequently are and considerably most, but they thinly are more then 0,5-1sm. A Lateral surface of such objects, advancing into depth, separete the tissue structures, squeezing them on neighbourhood.. Torn shallow vessels lightly trombs and bleeding frequently is insignificant.

If transversal object diameter small (needle, awl, spoke, tenon, dart), then hole is so the little, that can remain imperceptible, specially in secretive body allotments.  If prickly withoutribs object has a greater diameter is 5-10 ìì (for exp., round nail, stylet, rapier) and sharply expressed taper, if it outwardly not lustily ganoid, whether muddy, Then attached to immersion into body it can lay hold of epidermis and to rip away it on hole edge.  Hereupon post mortem fleeced edge wound something gets dry and forms a belt ofscratch, as in entrance gunshot hole. This circumstance not once presented by cause mistakes, when the chipped wounds set for gunshot and on the contrary. We must remember, that gunshot holes, as a rule, round form and have a cloth defect.

An example of stab objects  without edges

 

About that the prickly objects without ribs surface in the main separate, and do not impair the soft cloths, testifies a following example.

The Wounds from prickly objects without ribs surface are by its longer dimensions always disposed in-parallel to motion elastic retractive skin fibres - to Langer lines.

Langer lines (Lines on honour of german anatomist, which in 1861 y. in detail inquired into elastic buff properties ) - this round whether ribbone, straight whether sinuous fibres of connecting skin cloth.  If into some place number grow, then they unite between oneself by branches in net appearance,  which lightly stretch in area of fibres, and then acquires again primary appearance. Namely this is conditioned skin elasticity. Microscopic (on cuts, parallel to skin surface on the strength of all wound) in such wounds find the connecting-tissue of fibres in their edges, and also fibres vainglories breaks - into one whether both ends wounds. This is a lustily foam morphological sign, because sometimes only attached to histological research works well wound to deferentiate and so-and-so right to set the peculiarities of traumatizing implement.

In flat bone the prickly objects without ribs surface can form the hole fractures, which for its properties identical to gunshot, specially in skull vault bone.  Attached to action of prickly objects more large internal osseous plate underlie skull.vault,  on hard cerebral envelope, and attached to immediate stereomicroscopy in nudes spongy matter find the shallow osseous pieces. Attached to gunshot damages large pieces absent (they lustily crumble up and drop in by bullet into wound channel).

B. The stab objects  with edges are a bayonet, sharpened three- whether tetrahedral saw, stylet such,  screwdriver, ,  other objects with costal surface. A Body of such objects is grubbed out in pyramid appearance with sharp end. They can have 3, 4, 8, 6 and more ribs. A Transversal them cut has appearance of triangle, quadrangle, square, heel- whether hexagon. Damage for counting of ribs (and not borders)action,  and by what ribs less, that them corners more sharp and that greater traumatizing action they celebrate on cloths.

From action of prickly object with three ribs arise the wounds radiant for form  shallow,  because from each ribbing is generated on one slight tear. In most cases they do not compose no difficulties for diagnistics.

Object Bullock with four ribs form wounds of two appearances or this fourradial wound, each ray of which arises from action of separate ribbing, or oval wound,  on other edges of which symmetric disposed on one small slight tear. This depends on blowing place in damages and Langer lines disposition peculiarities.  Attached to action of flat four ribs object (for example, screwdriver with unrounded ribs) the wounds can have oval form with two short slights tear in both their ends. Amount of ribs in object determine for number of slights tear in wound.

A Prickly object with five ribs inundates the shallow fiveradial wounds. Rays from them short, no more 2-3 ìì, sometimes they carnage for length, from some one whether two ribs can grow up only small pressing traces,  because not always each rib well-off to bring on skin slight tear.

If acted prickly object from hexagonal ribs then in typical cases arise small oval wounds, disposed by its longer dimensions in-parallel to Langer lines.  However on edges of such wounds can be found on two superficial slights tear whether pressure disposed one to second. The wounds Ends accord with two ribs of prickly object, on two slights tear on edges - to accordingly four ribs. Such wounds properties are conditioned that ribs in prickly object with six ribs stupid, and not each from them not always can bring on skin break.

In prickly objects with greater amount of ribs the borders converge under lustily stupid (more 120°) corner, a transversal them cut comes around circle, that's why wounds from them oval, disposed in-parallel to Langer lines.  These wounds by almost nothing do not differ from wounds, formed by objects without ribs surface.

C. The stab objects with double-bladed flat are such objects, which have flat by wedge and handhold. If in blade one edge sharpened, and contrary - in appearance of Ï-identical formation, then object is prickle and back. To them belong the different knives:, hunter, kitchen, composes-ache, both blades edges are sharpened, then prickly object with two blades.. Among prickly objects in judicially-medical practice most frequent damage cause by namely such objects. Going deep plumb into man body,  is counted an implement whether arm do not slit (move apart) a cloth, and cut them. A Cut always makes a blade whether blades, and an edge personates auxiliary,  as if indicates, paves the way.

The Small wounds from double-edged prickly objects remind of wounds from prickly objects without tribs surface. Help in diferential diagnostics wounds (from objects action without ribs wound surface 0,5-1sm into length)size,  disposition of them on attitude to Langer lines (a little wounds from blade, that are found alongside, dispose independently to area of connecting-tissue skin fibers ) lines and. microscope stove research of space cuts. Attached to taking out blade of prickly object, with one whether two by blades from wound, bringing back it in wound whether impellent sacrifices arise additional cut is one or several. It is able sequential of basic cut, but usually bears off from it under some corner and lightly recognizes.

Ordinary the wounds by prickly objects with one whether two blades drift with pressure on. blade. This more frequent takes place blade grubbing out time from body. In that case is observed expressed prickly-cutting object.action,  which. Characterizes by combination of prickly and cutting action of blade and blade. Are generated authentic stab- sword-cuts: one end them sharp, rounded, Ï-.whether Ì-identical, like is intent on body, and contrary ÿâëÿº by oneself one of ends of sword-cut, which gets across into incision whether incision, or and that and other together. So, stab- sword-cuts arise from action of prickly objects with one whether two, by blades.

 

Morphological characteristics of self-made wounds

 

Ordinary law enforcement authorities whether law-court inquire, and judicially-medical examination can define by own whether outsider hand the caused damages attached to application of sharp objects. Settlement of this question redounds to outcome to set, was. in concrete case murder whether suicide. Damage, drifted to myself to oneself by own hand, not obligatorily presents by suicide. It may be and accidental.

Attached to damages by cutting objects on action of own hand (with view members mutilation of,  assault simulation,  suicide) indicate such trauma peculiarities whether circumstances:

   typical wounds localization on front body surface,  reachable for own hand: on neck, on front breasts (in heart allotment )surface,  on stomach, on front forearms surfaces,  radiocarpal and elbow jont.

   their multiplicity, paralel and surface. (

   sometimes winding of thin handhold of dangerous razor by rag piece,  other analogic object with view of better ficsation of blade into hand and brush defense from trauma;

 

 

   relatively palmar brush surface clean from blood,  which held cutting object (razor).

   for wounds from outsider (stranger) hands typical:

   transversal are disposed the fingers wounds and (whether) palms attached to self-defence, when that, who defends, grabs a knife blade whether dagger and attack with view of to unscrew his blow, wounds on brushes rear,  on. to back forearms surface,  shoulders also arising attached to attempt. To Be on the defensive;

   localization of one whether a little considerable wounds on any body allotment,  but overwhelmingly on neck, face, hands.

Damage by hewing objects often drift by outsider (stranger) hand with view murder of,  and dispose they, as a rule, on head. This one whether several big, oval wounds with some properties and bone cuttings with formation of numerous pieces. Under them - damage of cerebrum and his envelopes of different degree of expressing.

Damage by axe, drifted by own hand, have some  morphological peculiarities, which usually enable to solve a given question. For action own hands typical:

   multiplicity and damages surface.  Such combination lustily original in tie with impossibility to drift to myself to oneself biffs on head. By Own hand to do a humeral sweep by axe and to strike oneself on head it is impossible, that's why blows insignificant and done they only from hand whether ulnaris sweep. Namely multiplicity as if compensates surface, reflecting endeavor striking to drift to oneself the mortal damages. Amount of separate wounds, that meet in parallels instance, big - from a little ten to hundred and even more. Damage of soft cloths always more calculation, than kirve whether in bone, because some from blows cut only a skin;

   one direction and damages localization in most accessible places. The Veins and osseous kirve whether cuts are directed at the front back almost in-parallel one one and disposed in allotments frontal and parietal near sagittal suture. This is accounted for by that a more frequent axe is found in front of face and the blows drift by the medium of both hands by hand whether ulnaris sweeps;

   some regulation of hewing implement under blows time.  Majority of blows attached to attempt to finish a life drifts by axe.  Less of damages arises from action of middle part of blade and the hardly ever blows by own hand do not drift by axe sock.  By reason of it majority of damages on skin and in bone have form of grubbed out triangles (Ï-identical front end and sharp - back). Ï-identical forehand of these damages always more deep;

   lack of damages of head-dress. Suicidal, as governed, head a head in front of blowing on it in blows. If damage found and on head-dress, then this typically for hand action of outsider person (².Â.Ñêîï³í, 1960);

   absence signs of struggle and self-defence, typical for suicides. Impossibly to oneself to imagine a case, that man, to which blow in any amount of surface head damages by axe, does not accomplish attached to seventh support to attacked. Resistance whether even head regulation change will give rise to loss by damages of their properties (parallel, localization, so. on). Also ought also in the nature of things to appear wrestling signs and self-defence of different characteristics;

   founding on corpse other damages, entailed by other method or that also have properties, typical for action of own hand.

In cases of self-injury whether intentional mutilation of members by axe more often chop off the hands fingers whether legs.